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Ershiwuwei Shanhu Wan (Twenty-five-ingredient Coral Pill) is a traditional Tibetan medicinal formulation that has been used since the 8th century AD and is included in the 2020 edition of the Chinese Pharmacopoeia. The formulation consists of 25 medicinal materials, including 14 plant-based and 11 mineral-based ingredients, with coral serving as a key component. It is primarily indicated for the treatment of neurological and cerebrovascular disorders, including stroke, epilepsy, migraine, and hypertensive heart disease. The drug exerts its therapeutic effects by modulating multiple biological pathways, including the GRP78/XBP1/CHOP endoplasmic reticulum stress pathway, the Akt/mTOR/GSK-3β signaling axis, and the Keap1/Nrf2/HO-1 oxidative stress pathway. It is manufactured by several specialized companies, including Tibet Ganlu Tibetan Medicine and Jinhe Tibetan Medicine.
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